The Placebo Effect Has Its Place, Ctd

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Readers respond to a recent post:

One thing that’s often overlooked when talking about the placebo effect is that placebos can result in physical and measurable changes. In Parkinson’s, placebo doesn’t just affect the mind; it can affect the brain itself by increasing the release of dopamine, which can lead to the improvement of motor symptoms. I work in the Parkinson’s community and there is a strong interest among people living with the disease to harness placebo as a treatment in and of itself.

Of course that comes with significant ethical issues – the purposeful deception of patients as standard care is not an easy idea to swallow. However, there is perhaps one easy way around this quandary: tell patients they’re on a placebo. A study on irritable bowel syndrome published a few years ago found an improvement in symptoms when they did just that.

Another reader:

I think that Aidan O’Donnell has a skewed perspective on the placebo effect.

Rather than being “the added satisfaction patients derive from a treatment, over and above its actual benefits,” the placebo effect is in fact the baseline benefit against which the efficacy of medical treatments are measured. It does not refer to just a “feeling” of being better. It is a measure of actually being better in the same way as that achieved via medical treatment. In other words, our bodies are capable of some degree of healing without medical intervention, and our physiological processes are affected by our psychological state.

Another:

What Dr. O’Donnell seems to be missing is the fact that what people are looking for would be unethical for doctors to provide. People aren’t just looking to feel better; modern medicine does a pretty good job of managing pain. If all people wanted was more human contact and a small boost to overall well being and happiness, they could turn to a massage or some other spa treatment. What people want is an answer to their problems. They want to someone to tell them that it will be alright and that they can be fixed, and that the fix won’t be difficult or cause them pain. And so they turn to chiropractors and acupuncturists and homeopathic doctors. Because these people will tell them that they can make it better, even when they can’t (and they never can). Their success cases depend on the human body’s own recovery and the placebo effect. Their costs are small compared to real medical care, and they do no lasting harm, and you feel better when they are done. It’s easy to get sucked in.

Real medical doctors need to tell their patients the truth, that many times things look bad, and recovery may be long and painful. That isn’t to say that they don’t make mistakes, and that there are no improvements to be made. But it’s uncertainty that people are paying to get rid of, even if it’s a pleasant lie that they are buying.